Scott Schraff

Peritonsillar abscess in children : a 10-year review of diagnosis and management

OBJECTIVE peritonsillar abscess is the most common deep neck infection in adults and children. However, pediatric patients with their smaller anatomy and often inability to cooperate with exam and treatment, provide a challenge. This study reviews the experience over the last 10 years at a childrens hospital in the diagnosis and treatment of pediatric peritonsillar abscess. METHODS a retrospective chart review of 83 children diagnosed with a peritonsillar abscess by the Otolaryngology service over a 10-year period (March 1989-February 1999) were reviewed. Presenting signs and symptoms, physical findings, age, season of presentation, prior pharyngitis history, and prior treatment was collected from the charts. Additionally, diagnostic studies (if any), treatment performed, bacteriology, and outcome/complications were noted. RESULTS due to either an inability to cooperate fully for examination and treatment, or because of an earlier history of significant recurrent pharyngitis or obstructive tonsillar hypertrophy, half of the children required treatment in the operating room. Twenty-six out of 83 (31%) underwent a quinsy tonsillectomy. Length of stay was relatively short (0.9 days). There were no recurrent PTAs in our series, although four children initially treated with incision and drainage required tonsillectomy for persistent symptoms or residual abscess. Ten of those not treated with tonsillectomy (19%) required interval tonsillectomy for recurrent pharyngitis. CONCLUSION limited by the ability to cooperate with treatment, children often require different treatment plans. We offer a treatment algorithm for managing children with PTAs that takes into account their age, level of cooperativeness, co-morbidities and prior history of pharyngitis, PTA or obstructive sleep disorder.

Differential Capture of Serum Proteins for Expression Profiling and Biomarker Discovery in Pre‐ and Posttreatment Head and Neck Cancer Samples

Introduction: A long‐term goal of our group is to develop proteomic‐based approaches to the detection and use of protein biomarkers for improvement in diagnosis, prognosis, and tailoring of treatment for head and neck squamous cell cancer (HNSCC). We have previously demonstrated that protein expression profiling of serum can identify multiple protein biomarker events that can serve as molecular fingerprints for the assessment of HNSCC disease state and prognosis.

“Window Shade” Tympanoplasty for Anterior Marginal Perforations

Objectives/Hypothesis: Anterior marginal perforations of the tympanic membrane often present a reconstructive challenge to the otolaryngologist. Poor surgical outcomes are often due to inadequate exposure, a lack of residual tympanic membrane, impaired vascular supply, and delayed healing. This study reports on the success of the “window shade” technique, combining aspects of both the traditional underlay and overlay tympanoplasty techniques, for the management of anterior marginal tympanic membrane perforations.

09:40 AM: Immunomodulatory Genes in CMV-Related Inner Ear Injury

children underwent tonsillectomy, and the results from that group are reported. Follow-up QOL surveys were received from 58 children at 6 months and 38 children at one year. Although the enrollment criteria was recurrent infection, the children showed significant improvements in all six subscales of the disease-specific QOL instrument (TAHSI) at 6 months and 1 year: airway and breathing, infection, health care utilization, and cost of care (all p 0.0001), eating and swallowing (p 0.0007), and behavior (p 0.01). Significant improvements were also found on several subscales of the global QOL instrument (CHQ-PF28), such as general health perceptions (p 0.0002), physical functioning (p 0.0001), parental impact, emotional and time (p 0.0004 and 0.001), and family activities (p 0.0001). CONCLUSION: After tonsillectomy for recurrent and chronic tonsillitis, large improvements in disease-specific and global QOL were found. SIGNIFICANCE: Most prior studies on tonsillectomy for recurrent tonsillitis have assessed only the frequency of infections as an outcome measure. This study provides prospective evidence of the effectiveness of tonsillectomy on children’s quality of life. SUPPORT: American Academy of Otolaryngology Head and Neck Surgery.

Pediatric Cholesteatoma: A Retrospective Review:

Abstract Problem: This study addressed the surgical management of pediatric cholesteatoma. Methods: The study is a 10-year retrospective review of children undergoing surgical intervention for cholesteatoma at a tertiary care pediatric hospital between July 1, 1993 and December 30, 2002. Results: During the study period 278 children underwent surgical resection of their cholesteatoma. Of these children, 221 were managed via an intact canal wall approach while the remaining 57 underwent an open cavity procedure. The overall recurrence rate in this series was 16%. Ossicular reconstruction, if necessary, was performed in a staged fashion in 89% of the intact canal wall group. Hearing results along with postoperative complications will be presented. Conclusion: Management of pediatric cholesteatoma requires a highly individualized approach that takes into account anatomic, clinical, and social factors to determine the most successful surgical treatment paradigm. Significance: The optimal treatment for pediatric cholesteatoma remains a controversial issue. Management decisions including intact canal wall versus open cavity techniques, second-look procedures, and staging ossicular reconstruction continue to be debated. Support: None reported.

Newborn and childhood hearing loss: the effect of newborn hearing screening

Problem: To study the effect of newborn hearing screening by identifying and characterizing hearing loss in a consecutive cohort of newborns and children referred to our tertiary-care children’s hospital. Methods: The records of pediatric patient with the diagnosis of sensorineural hearing loss (SNHL), mixed hearing loss, and unspecified hearing loss from June 1, 1999, to December 1, 2002, were reviewed. Data collected included prenatal and postnatal risk factors for hearing loss, method of identification, diagnostic work-up, and hearing loss evaluation results. Results: 508 pediatric patient records with a hearing loss diagnosis were reviewed, of which 436 had all relevant data. 26 of 436 presented after failing universal newborn screening, and 20 of these failed additional testing and were diagnosed with hearing loss. These children had a median age of 4 months (interquartile range [IQR], 3-8 months) and 7 (35%) had no hearing loss risk factors. Of the additional 410 referred through traditional screening methods, 286 (70%) were eventually diagnosed with hearing loss. The median age of these children was 5 years (IQR, 2-9 years). The false-positive rate was 23% for UNHS and was 30% for traditional screening. In total, 306 (70%) of the 436 children referred for hearing evaluation actually had hearing loss. Conclusion: UNHS has markedly reduced the median age of diagnosis of those with newborn and childhood hearing loss and identified a significant percentage with no risk factors. Significance: With the institution of UNHS, we anticipate dramatic medical, social, and economic benefits for children born with hearing loss. Support: None reported.